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PDFWAC 182-551-1820

Pediatric palliative care (PPC) contact—Services included and limitations to coverage.

(1) The medicaid agency's pediatric palliative care (PPC) case management/coordination services cover up to six pediatric palliative care contacts per client, per calendar month, subject to the limitations in this section and other applicable WAC.
(2) One pediatric palliative care contact consists of:
(a) One visit with a registered nurse, social worker, or therapist (for the purpose of this section, the medicaid agency defines therapist as a licensed physical therapist, occupational therapist, or speech/language therapist) with the client in the client's residence to address:
(i) Pain and symptom management;
(ii) Psychosocial counseling; or
(iii) Education/training.
(b) Two hours or more per month of case management or coordination services to include any combination of the following:
(i) Psychosocial counseling services (includes grief support provided to the client, client's family member(s), or client's caregiver prior to the client's death);
(ii) Establishing or implementing care conferences;
(iii) Arranging, planning, coordinating, and evaluating community resources to meet the client's needs;
(iv) Visits lasting twenty minutes or less (for example, visits to give injections, drop off supplies, or make appointments for other PPC-related services.); and
(v) Visits not provided in the client's home.
(3) The medicaid agency does not pay for a pediatric palliative care contact described in subsection (2) of this section when a client is receiving services from any of the following:
(a) Home health program;
(b) Hospice program;
(c) Private duty nursing (private duty nursing can subcontract with PPC to provide services)/medical intensive care;
(d) Disease case management program; or
(e) Any other medicaid program that provides similar services.
(4) The medicaid agency does not pay for a pediatric palliative care contact that includes providing counseling services to a client's family member or the client's caregiver for grief or bereavement for dates of service after a client's death.
[Statutory Authority: RCW 41.05.021, Section 2302 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), and Section 1814 (a)(7) of the Social Security Act. WSR 12-09-079, § 182-551-1820, filed 4/17/12, effective 5/18/12. WSR 11-14-075, recodified as § 182-551-1820, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-18-033, § 388-551-1820, filed 8/30/05, effective 10/1/05.]
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